10-144-332 Me. Code R. § 2-11

Current through 2024-51, December 18, 2024

Section 144-332-2-11 - APPLICATION PROCESS

I. An application is a signed request for MaineCare coverage made through one of the following methods:

A. a document approved by OFI as an application form;

B. the My Maine Connection website;

C. the Federally Facilitated Marketplace (FFM) (https://www.healthcare.gov/);

D. The State Based Marketplace (SBM) (https://CoverME.gov); or

E. the telephone or fax machine

II. The individual or someone acting on the individual's behalf may sign the application form. The applicant may choose anyone to help in completing the form.

III. The date of application is the date the signed application form is received in any OFI office, the FFM, or the SBM. For presumptive eligibility, the date the form is signed and dated by both the applicant and the designated person at specified provider sites is considered the date of application (See Part 9 Section 4(2)(C) and Part 18, Section 4).

IV. All signed applications are acknowledged in writing. A written decision of eligibility is sent to the applicant.

V. A denied application is valid for the month of application and the following month. If new or required information is received to re-evaluate eligibility before the last day of the month following the application month, a new application is not required.

VI. All applicants or re-applicants for MaineCare are given information in writing, or verbally if appropriate, about the following:

A. services covered under MaineCare,

B. conditions of eligibility,

C. the individual's rights, including the right to an Administrative Hearing,

D. responsibilities of recipients, including reporting changes within ten days (See Section 12.2 of this Part), and E. the 45-day application processing standard (See Section 12.3.1 of this Part).

Section 11.1:Subsequent requests for eligibility

An individual does not need to complete a new application form if:

I. open MaineCare and requesting eligibility for new members orally or in writing. The application date for the new member is the date the request is made. Additional information may still be needed to determine eligibility.

II. open under one MaineCare program (for example Medicaid) and requesting coverage under another MaineCare program (for example Buy-in). In this situation the application date is the date that the request is made, either orally or in writing. Additional information may still be needed to determine eligibility.

III. open MaineCare and now requesting coverage in a facility or Home and Community Based Waiver services. Additional information may still be needed to determine eligibility.

IV. SSI recipients moving to a residential care facility where SSI benefits continue. Additional information may still be needed to determine eligibility.

SSI Individuals who move to a nursing facility need to complete an application. Community coverage is to be kept open while determining eligibility in the facility.

A reapplication is any signed application form received after the notice period (See Section 15 of this Part). This includes review forms returned after that period.

Section 11.2:Recipients of SSI or State Supplement

Individuals and couples who are aged, blind, or have disabilities, who are recipients of SSI or State Supplement are automatically covered as Categorically Needy unless they refuse to assign their rights to payments for medical care. A separate application for Medicaid (including coverage for any Home and Community Based Waiver program) is not needed for these groups.

10-144 C.M.R. ch. 332, § 2-11